Healthcare News & Insights

Are hospital cleaning protocols good enough for decontamination?

Acinetobacter baumannii is a significant pathogen associated with hospital-acquired infections (HAIs). It colonizes and infects hospitalized patients, leading to increased morbidity and morality, especially in intensive care and burn units. And a recent study found hospital cleaning protocols may be inadequate when it comes to decontamination of multidrug-resistant (MDR) Acinetobacter baumannii.

The study, which was published in the December issue of the American Journal of Infection Control, found that over half of the rooms that tested positive for Acinetobacter baumannii bacteria prior to cleaning remained contaminated after cleaning occurred.

Study methodology

Researchers from the University of Maryland Medical Center tested the rooms of patients with a known history of colonization or infection with MDR Acinetobacter baumannii in the medical, surgical and cardiac surgery ICUs.

When the patients were to be discharged from their rooms, samples were collected. After the rooms were cleaned by environmental services, who were unaware of the study, and before a new patient was admitted, samples were collected from the following areas:

  • sink drain and edge of basin
  • buttons of bed rails
  • bedside table handle
  • vital sign monitor buttons
  • call button/remote
  • supply cart drawer handles
  • interior and exterior door handles
  • infusion pump buttons
  • ventilator machine buttons, and
  • the floor on either side of the bed.

The cleaning method employed at the University of Maryland Medical Center is a “top-down”one where the highest surfaces are cleaned first and the cleaning continues downward. Wipes saturated with Virex II 256, a quaternary ammonium compound-based, hospital-grade disinfectant, were used to clean all of the surfaces, and a new wipe was sued on each surface to avoid cross contamination.

Cleaning results

In a two-year period, 487 cultures were collected from 32 rooms. Before cleaning, 41 sites (15.3%) in 15 rooms tested positive for MDR Acinetobacter baumannii. The areas with the highest contamination rate prior to cleaning were:

  • floor (12/32, 37.5%)
  • supply cart (7/30, 23.3%)
  • bed rails (5/24, 20.8%), and
  • ventilator (3/15, 20.0%).

After cleaning took place, eight rooms (25%) in 12 different areas tested positive for MDR Acinetobacter baumannii. But all of the rooms that tested positive after the cleaning process, were positive before the cleaning process. No room that tested negative before the cleaning process tested positive after the process.

The areas that tested positive most often after the cleaning process were:

  • floors (4/32, 12.5%)
  • bedside tables (2/27, 7.4%)
  • call buttons (2/20, 10%)
  • door handles (3/32, 9.4%), and
  • supply carts (1/26, 3.8%).

Alternate methods

The study shows that the current cleaning methods employed at hospitals may not be adequate when it comes to decontamination of MDR organisms.

The study authors noted that methods such as hydrogen peroxide vapor and ultraviolet light have been shown to be significantly more effective at decontamination, but are hindered by time constraints. Therefore, further studies are needed to find the optimal cleaning method for disinfecting rooms to eliminate MDR organisms.

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